Dexamethasone have so many uses in ophthalmology, dermatology, immunology and even Hematology. It is a semi-synthetic corticosteroid that is similar with the Steroids secreted within the adrenal cortex. However, they are different from the Anabolic steroids which are used by body builders or athletes to enhance performance.
Unlike the Anabolic steroids, dexamethasone use just like other corticosteroids causes muscle wasting and weight gain. Consequently, this side effect of weight gain with dexamethasone is being utilized by individuals especially females who wish to add some weight.
Clinically, Dexamethasone has so many uses which includes; management of Arthritis, Asthma, blood and immune system disorders, allergic reactions, certain skin and eye conditions and certain cancers.1 However, wrong or overuse of dexamethasone have so many side effects that may pose a great risk to health. Therefore, it is important you seek a professional advice before using this drug for weight gain or any other unofficial use.
Dexamethasone mechanism of action
Dexamethosone just like cortisol has more of glucocorticoid activity and less or no mineralocortocoid activity. Hence, Action of this drug is more on metabolism rather than salt and water retention.
Nevertheless, dexamethasone expresses its receptors inside the cytosols of so many cells. Being an analogue of cholesterol, it easily crosses the cell membrane to bind with its receptor to form a dimer complex. This complex is transported into the DNA to form the messenger RNA (mRNA). mRNA causes the synthesis of enzymes which alter the cell function.
The type of enzyme produced determines the action of the drug. But generally, on metabolism, dexamethasone causes the mobilization of fats from the adipose tissues for the production of energy. Protein is degraded to amino acids while there is decrease in the take of glucose by the cells. This usually increases the blood content of sugar and can lead to diabetes.
Dexamethasone uses also have actions on electrolytes; it decreases the absorption of calcium and calcification of bones. This action makes the bone too fragile and easy to break. It also causes the excretion of potassium and Hydrogen ion, while Sodium and water is reabsorbed. Consequently, this drug can cause hypertension, muscle weakness and Alkalosis.
Finally, on blood cells, it can keep the macrophages and leucocytes away from the blood ( reason for its immunosuppressive ability and anti-inflammation). But, the number of circulating neutrophils and Red blood cells increases.
Uses of Dexamethasone/ Indications
As said earlier, dexamethasone has a wide variety of uses, but here are few most common uses.
Management of inflammation
Glucocorticoids in general have the ability to redistribute leucocytes and other agents that cause inflammation away from the blood to other compartments of the body. Thereby, there is a decrease in the production of Prostangladins and leucotrienes that initiates redness, swelling, heat and tenderness.
Rheumatoid Arthrirtis, Osteoarthritis, Conjunctivitis and other inflammatory diseases responds to dexamethasone therapy.
Treatment of allergy
Dexamethasone can treat drug allergy, blood transfusion reaction, Bronchial asthma, allergic rhinitis and other forms of allergy. They do this by reducing the concentration of the leucocytes and macrophages in the blood stream. In addition, this drug can stabilize the mast cells and inhibit the release of substances of anaphylaxis that can trigger allergy.
Lung Maturation of a fetus
Premature infants usually suffer from Respiratory distress syndrome. A dose of dexamethasone administered intramuscularly to the mother 48 hours prior to birth helps to improve the lung capacity of the fetus.
Diagnosis of Cushing syndrome
Cushing syndrome is due to the over secretion of the glucocorticoids, particularly cortisol. Dexamethasone is the drug of choice for the diagnosis of this disease. There are two ways to do this test; the standard two-day test and the overnight test. High serum cortisol level in the morning after a low dose of dexamethasone at night is an indication of cushing syndrome.2
Treatment for Congenital Adrenal Hyperplasia
Congenital adrenal hyperplasia is a group of diseases that is a result of enzyme disorder that affects the synthesis of one or more of the adrenal steroid hormones. In this condition, there is over production of the adrenal androgen or the sex hormone which may cause female to have male characteristics.
The administration of dexamtheasone can help regulate the synthesis or overproduction of these hormones.
Dexamethasone uses for weight gain
One of the ways to misuse this drug is the use of the drug for weight gain. In that case, the danger lies with the use of the drug without a doctor’s prescription and proper drug monitoring. This poses a threat to users after a long term use of the drug.
The mechanism to which dexamethasone cause weight gain is not totally clear. However, this drug improves the appetite of the user.3 Also, dexamethasone deposits fats to the trunk, buttocks and the face.
Dosage of dexamethasone
The dosage of dexamethasone depends on the disease and its severity. Nevertheless, it is best to start the treatment with the lowest dose. The titration of the dose is gradual till a stable dose for the treatment is reached.
However, For inflammation, low doses of 0.75 mg/day is recommended, you can increase up to 9 mg/day. The total daily dose is into 2 to 4 divided doses throughout the day. This applies to intravenous, intramuscular, and oral administrations. When dexamethasone is directly on lesions or a membrane such as the airways, the dose can be reduced to 0.2 to 6 mg per day.4
While other life-threatening diseases such as cerebral edema, circulatory shock or multiple myeloma may require a higher dose of the drug. The problem with this high dose treatment is the development of adrenal insufficiency; which means the body will find it hard to produce the glucocorticoids.5
Side effects of Dexamethasone
- Hyperglycermia/ Diabetes
- Osteoporosis or bone breakage
- Potasium depletion
- Abnormal redistribution of fat
- Immune Suppression
- Delayed wound healing
- Mood/ Emotional disorders
- Muscle wasting
- Stunted growth
- Abnormal hair growth for women
How to minimize side effects of dexamethasone
Dexamethasone is a safe drug and is easy to tolerate. But, the drug can present so many side effects when in the case of misuse or overuse. In addition, Some diseases or drug interactions can make the use of dexamethasone not safe.
Finally, the body system can easily depend on dexamethasone after a long time. Hence, discontinuation of the drug has to be gradual to avoid withdrawal symptoms.
Below are ways you can use dexamethasone to get the minimal side effects.
Usually, the chronic use of dexamethasone tend to suppress the normal production of the body’s natural hormone (cortisol). Abrupt withdrawal of the drug can cause serious withdrawal symptoms. Therefore, the best way is to tapper the dose. Meaning, the dose of the drug is reduced gradually till the minimal dose that will not cause rebound of the disease is reached.
In conclusion, it is important to know that the withdrawal symptoms can present in so many ways. So, it is important to talk to your doctor if you notice anything unusual when trying to stop the drug. However, these symptoms are common to dexamethasone withdrawal; weakness, fatigue, decreased appetite, weight loss, nausea, vomiting, diarrhea, abdominal pain.6
These small tips may help you to minimize side effects when using the drug.
- Do not take life or attenuated vaccine when on any corticosteroid since it might make the microorganism in the vaccine to overwhelm your system.
- Dexamethasone should be used with caution during pregnancy. Studies have shown that dexamethasone is tetratogenic and can cause cleft palate to babies.
- Latent diseases such as tuberculosis, Candidiasis and Toxoplasmosis may become active and virulent in the presence of dexamethasone due to immune suppression. Therefore, be careful about this drug if you have a compromised immune system.
- It is important to observe a proper hygiene when on this drug since contracting a disease may become easier.
- Elderly folks especially post menopausal women should try to take Calcium supplement to minimize the risk of osteoporosis (bone weakness or breakage).
- Talk to your doctor if you notice excessive weight gain, depression or mood changes. Also, there is need for close monitoring of the outcome of treatment to know when to discontinue the drug.
- If you do not wish to gain weight when taking dexamethasone, it is important that you watch your calories and exercise often.
- On long term use of the drug, your body response to stress decreases. Tell your doctor about the drug you are using especially when you will experience a stressful process such as surgery.
- Monitor your blood pressure and sugar level when on the drug.7